Clinical note

Most insurance companies require documentation to establish medical necessity for genetic testing. Additionally, GeneDx requires that same information to initiate exome and genome testing. 

Documentation with the following information must be submitted with an exome or genome order: 

• Why exome/genome is the most appropriate test for your patient based on their personal and family history (e.g., clinical notes and previous test results) 

• How testing results could potentially impact management, including explicit details and examples (e.g., clinical notes) 

• If applicable, documentation that genetic counseling was performed (e.g., separate genetic counseling consult note or documentation of counseling by the ordering provider) 

GeneDx offers customizable templates to help you establish medical necessity for exome and genome testing.  

ICD-10 codes

For tests orders being submitted to a patient’s insurance, submission of all relevant ICD-10 codes is critical to support the medical necessity of the test being ordered.  

• The primary ICD-10 code is the code most relevant to the diagnosis for the test being ordered. 

• Additional relevant ICD-10 codes should be submitted. 

• For exome testing, more than one diagnosis code is often needed to support medical necessity. 

Click here to access a list of frequently used ICD-10 codes for neurodevelopmental disorders.